The Chieme Seeknee Replacement Clinic CRC CiSa Sports Clinic

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The Chiemsee Knee Replacement Clinic (CKRC), situated at the northern edge of the German Alps, is a specialized sports clinic focusing on knee replacements for skiers from Germany, Austria, Switzerland, and Italy. The clinic operates with a single operating room (OR), but faced with increasing demand, management considers adding a second OR. A lean consulting firm recommends assessing the current utilization of the existing OR before expanding capacity, to determine whether current operations could be optimized to meet demand more efficiently.

Data collected by the consulting firm indicate that the OR is available for 12 hours daily, with no procedures scheduled between 7 pm and 7 am, dividing the operational time equally among three surgeons. The standard procedure duration for knee surgeries at the clinic is one hour; additional post-operative cleaning and housekeeping require 20 minutes per procedure, but this cleaning time could be largely reduced if the cleaning crew is notified earlier. Patient preparation and anesthesia work before each procedure take approximately 10 minutes and can be scheduled outside of the OR. Surgeons only commence cases if all phases—preparation, procedure, and cleaning—can be completed within their allocated 4-hour window, and they do not start earlier than their scheduled time. While the clinic aims for seven-day operation, holidays, vacations, and construction lead to an average of one day per week when the OR is unavailable.

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To accurately determine the utilization and efficiency of the OR at CKRC, it is essential to analyze the current workflow, capacity, and scheduling practices. The primary objectives are to establish the average number of cases performed per day when the OR is in use, and to evaluate the overall equipment effectiveness (OEE), a metric that assesses the productive time of the hospital's operating resources relative to their total available time.

Calculating the Average Number of Cases per Day

The OR operates within a scheduled window of 12 hours each day, which, given the clinic's policies, are from 7 am to 7 pm. It is also noted that approximately 4 hours per surgeon are available each day, considering three surgeons sharing the time equally. Since the standard procedure lasts 1 hour, and surgeons only begin cases if they can complete all phases—including preparation, the procedure itself, and cleaning—within their 4-hour time slot, we need to determine how many surgeries can fit during this period.

Each case involves a setup phase of 10 minutes, the surgical procedure of 60 minutes, and a cleaning phase of 20 minutes, totaling 90 minutes per case if scheduled sequentially. However, the possibility of moving patient preparation outside the OR reduces the intraoperative preparation time, leaving potentially less than 90 minutes for each case’s in-OR activities. Given that preparation can be scheduled separately, focused on the minimal surgical time frame, the effective intraoperative time per case can be considered approximately 60 minutes for the procedure itself, with 20 minutes for cleaning that could be sequentially scheduled immediately after the procedure, provided the cleaning crew is notified early to save time.

Assuming that the cleaning can be efficiently integrated into the workflow with earlier notification, the minimal necessary intraoperative time per case becomes approximately 60 minutes, with cleaning time adjacent to the procedure, avoiding delays. Since each surgeon has a maximum of 4 hours (240 minutes) per day, and each case involves 1 hour of surgery, the maximum number of cases per surgeon per day is theoretically 4 cases, provided the workflow is optimized and no delays occur.

Furthermore, considering the distribution of surgical time among three surgeons and the total available time, the total number of cases per day is limited by the sum of all surgeons' capacity. If each surgeon can perform up to 4 cases during their 4-hour window, the total number of cases per day is 12 cases (3 surgeons x 4 cases each). However, this is an ideal scenario, assuming perfectly optimized workflow, no delays, and immediate cleaning upon case completion.

Calculating the Overall Equipment Effectiveness (OEE)

OEE measures how effectively the OR is utilized based on three components: availability, performance, and quality. For CKRC, the availability component considers the actual operational hours versus scheduled hours. Since the clinic operates for 12 hours daily, with an average of one day per week lost due to holidays and maintenance, the effective weekly operating hours are approximately 11 hours per day × 6 days = 66 hours, or roughly 396 hours per month if operating continuously during those days.

Availability can be quantified as the ratio of actual operating time to scheduled time, which in this context considers scheduled capacity minus unavailable days. Performance reflects how well the OR is utilized during operational hours, i.e., whether it operates at maximum capacity. If the total number of cases performed matches the optimal capacity calculated earlier (up to 12 cases per day), then the performance is high. Quality pertains to the percentage of procedures conducted without complications or re-operations; absent specific data on quality, we assume a high standard of care resulting in a quality factor close to 1 (or 100%).

Given these assumptions, the OEE can be approximated as: Availability × Performance × Quality. Assuming a 90% utilization of scheduled hours due to minor delays, and the optimal capacity being 12 cases per day, the OEE would be roughly 0.9 (availability) × 1 (performance, assuming maximum utilization) × 1 (quality) = 0.9, or 90%.

Conclusion

Analysis indicates that, with optimized workflow and scheduling, the OR at CKRC can handle approximately 12 knee replacement cases per day when in use. The OEE of the OR is estimated at around 90%, reflecting high utilization with some minor inefficiencies. These findings suggest that before investing in additional capacity, the clinic could improve throughput by scheduling more efficiently and possibly reducing turnaround times, especially with better coordination of cleaning and preparation tasks. If further demand persists beyond this optimized capacity, expansion in capacity—such as adding a second OR—could then be justified to prevent bottlenecks and minimize patient wait times.

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